Urinary Incontinence

  • Incontinence
  • Symptoms
  • Causes
  • Treatment

Urinary Incontinence

Urinary Incontinence is the loss of bladder control. It is a common and often embarrassing problem. The severity ranges from occasionally leaking urine when you cough or sneeze to having an urge to urinate that's so sudden and strong you don't get to a toilet in time.

Symptoms of Urinary Incontinence

Some people experience occasional, minor leaks of urine. Others wet their clothes frequently.

Types of urinary incontinence include:

 Stress incontinence. Urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy.
 Urge incontinence. You have a sudden, intense urge to urinate followed by an involuntary loss of urine. You may need to urinate often, including throughout the night. Urge incontinence may be caused by a minor condition, such as infection, or a more severe condition such as neurologic disorder or diabetes.
 Overflow incontinence. You experience frequent or constant dribbling of urine due to a bladder that doesn't empty completely.
 Functional incontinence. A physical or mental impairment keeps you from making it to the toilet in time. For example, if you have severe arthritis, you may not be able to unbutton your pants quickly enough or maybe you are in a wheelchair and cannot negotiate the trip to the bathroom in time.
 Mixed incontinence. You experience more than one type of urinary incontinence, for example urge plus stress incontinence. 40% of incontinent women have mixed incontinence.

Causes of Urinary Incontinence

Urinary incontinence can also be a persistent condition caused by underlying physical problems or changes, including:

 Pregnancy. Hormonal changes and the increased weight of the uterus can lead to stress incontinence.
 Childbirth. Vaginal delivery can weaken muscles needed for bladder control and also damage bladder nerves and supportive tissue, leading to a dropped (prolapsed) pelvic floor. With prolapse, the bladder, uterus, rectum or small intestine can get pushed down from the usual position and protrude into the vagina. Such protrusions can be associated with incontinence.
 Changes with age. Aging of the bladder muscle can decrease the bladder's capacity to store urine.
 Menopause. After menopause women produce less estrogen, a hormone that helps keep the lining of the bladder and urethra healthy. Deterioration of these tissues can aggravate incontinence.
 Hysterectomy. In women, the bladder and uterus are supported by many of the same muscles and ligaments. Any surgery that involves a woman's reproductive system, including removal of the uterus, may damage the supporting pelvic floor muscles, which can lead to incontinence.
 Obstruction. A tumor anywhere along your urinary tract can block the normal flow of urine, leading to overflow incontinence. Urinary stones — hard, stone-like masses that form in the bladder — sometimes cause urine leakage.
 Neurological disorders. Multiple sclerosis, Parkinson's disease, stroke, a brain tumor or a spinal injury can interfere with nerve signals involved in bladder control, causing urinary incontinence.
 Genetics. Studies appear to indicate a role for genetic predisposition for prolapse and incontinence as well as a possible connective tissue deficiency in affected women that may be genetically linked. Studies are ongoing.

Treatment of Urinary Incontinence

Treatment for urinary incontinence depends on the type of incontinence, its severity and the underlying cause. A combination of treatments may be needed.

Behavioral Techniques

 Bladder training, to delay urination after you get the urge to go. You may start by trying to hold off for 10 minutes every time you feel an urge to urinate. The goal is to lengthen the time between trips to the toilet until you're urinating only every two to four hours.
 Scheduled toilet trips, to urinate every two to four hours rather than waiting for the need to go.
 Fluid and diet management, to regain control of your bladder. You may need to cut back on or avoid alcohol, caffeine or acidic foods. Reducing liquid consumption, losing weight or increasing physical activity also can ease the problem.

Pelvic Floor Muscle Exercises

Also known as Kegel exercises, these techniques are especially effective for stress incontinence but may also help urge incontinence. The goal is build up the muscles involved in control of urination.

To do pelvic floor muscle exercises, imagine that you're trying to stop your urine flow.

 While urinating, try to stop and start the urine flow using the muscles that control the flow. After identifying them, you will no longer need to do this on the toilet.
 Next try to contract them 40 times in the morning and 40 times at night while brushing your teeth. Try to hold the contraction for 5 seconds.
 Tighten (contract) the muscles you would use to stop urinating and hold for five seconds, and then relax for five seconds. (If this is too difficult, start by holding for two seconds and relaxing for three seconds.)
 Work up to holding the contraction for 10 seconds.

To help you identify and contract the right muscles, we may suggest you work with a physical therapist or try biofeedback techniques.

Electrical Stimulation

Electrodes are temporarily inserted into your rectum or vagina to stimulate and strengthen pelvic floor muscles. Gentle electrical stimulation can be effective for stress incontinence and urge incontinence, but you may need multiple treatments over several months

Medications

Medications commonly used to treat incontinence include:

 Anticholinergics. These medications can calm an overactive bladder and may be helpful for urge incontinence. Examples include oxybutynin (Ditropan XL), tolterodine (Detrol), darifenacin (Enablex), fesoterodine (Toviaz), solifenacin (Vesicare) and trospium (Sanctura).
 Mirabegron (Myrbetriq). Used to treat urge incontinence, this medication relaxes the bladder muscle and can increase the amount of urine your bladder can hold. It may also increase the amount you are able to urinate at one time, helping to empty your bladder more completely.
 Topical estrogen. Applying low-dose, topical estrogen in the form of a vaginal cream, ring or patch may help tone and rejuvenate tissues in the urethra and vaginal areas. This may reduce some of the symptoms of incontinence.

Medical Devices

Devices designed to treat women with incontinence include:

 Pessary, a stiff ring that you insert into your vagina and wear all day. The device helps hold up your bladder, which lies near the vagina, to prevent urine leakage. You may benefit from a pessary if you have incontinence due to a prolapsed bladder or uterus.
 Pads and protective garments. Most products are no more bulky than normal underwear and can be easily worn under everyday clothing.
 Catheter. If you're incontinent because your bladder doesn't empty properly, you can learn to insert a soft tube (catheter) into your urethra several times a day to drain your bladder.

Interventional Therapies

Interventional therapies that may help with incontinence include:

 Bulking material injections. A synthetic material is injected into tissue surrounding the urethra. The bulking material helps keep the urethra closed and reduce urine leakage. This procedure is generally much less effective than more-invasive treatments such as surgery for stress incontinence and usually needs to be repeated regularly. It is used primarily for patients that cannot tolerate outpatient surgery.
 Botulinum toxin type A (Botox). Injections of Botox into the bladder muscle may benefit people who have an overactive bladder. Botox is generally prescribed to people only if other first line medications haven't been successful. It is expensive and will only last about 6 months.
 Nerve stimulators. A device resembling a pacemaker is implanted under your skin to deliver painless electrical pulses to the nerves involved in bladder control (sacral nerves). Stimulating the sacral nerves can control urge incontinence if other therapies haven't worked. The device may be implanted under the skin in your buttock and connected directly to the sacral nerves or may deliver pulses to the sacral nerve via a nerve in the ankle. This is usually only an option if other first line medications have failed.

Surgery

If other treatments aren't working, several surgical procedures can treat the problems that cause urinary incontinence:

 Sling procedures. Synthetic material or mesh are used to create a pelvic sling around your urethra and the area of thickened muscle where the bladder connects to the urethra (bladder neck). The sling helps keep the urethra closed, especially when you cough or sneeze. This procedure is used to treat stress incontinence.
 Bladder neck suspension. This procedure is designed to provide support to your urethra and bladder neck — an area of thickened muscle where the bladder connects to the urethra. It involves an abdominal incision, so it's done during general or spinal anesthesia.
 Prolapse surgery. In women with urinary incontinence and pelvic organ prolapse, surgery may include a combination of a sling procedure and prolapse surgery.

Absorbent Pads and Catheters

If medical treatments can't completely eliminate your incontinence, you can try products that help ease the discomfort and inconvenience of leaking urine:

 Pads and protective garments. Most products are no more bulky than normal underwear and can be easily worn under everyday clothing. Men who have problems with dribbles of urine can use a drip collector — a small pocket of absorbent padding that's worn over the penis and held in place by close-fitting underwear.
 Catheter. If you're incontinent because your bladder doesn't empty properly, your doctor may recommend that you learn to insert a soft tube (catheter) into your urethra several times a day to drain your bladder. You'll be instructed on how to clean these catheters for safe reuse.